Decreased Serum Adiponectin Level during Catecholamine Crisis in an Obese Patient with Pheochromocytoma

Abstract

We herein report the case of a 37-year-old man with both pheochromocytoma and visceral fat accumulation and describe the sequential changes in his adiponectin levels throughout the clinical course from catecholamine crisis until the follow-up for adrenalectomy. His adiponectin level decreased during catecholamine crisis and increased after adrenalectomy. However, his adiponectin level decreased again at two years postoperatively when his visceral fat area greatly increased. This case suggests that catecholamines and visceral fat volume may affect adiponectin metabolism in subjects with pheochromocytoma, which may precipitate cardiovascular complications in this endocrine disease.

Keywords: adiponectin; pheochromocytoma; visceral fat area.

Figure 1.

At the time of admission, abdominal CT imaging showed a left adrenal tumor, inhomogeneous inside and surrounded by panniculitis [diameter 65 mm (arrow)] and visceral fat area of 153 cm² (A). On day 8, CT showed necrosis in the left adrenal tumor (arrow) and periadrenal fat stranding (B).

Figure 2.

Macroscopic examinations of the resected tumor revealed massive necrosis, probably due to ischemia rather than tumor necrosis (A). Hematoxylin and Eosin staining (×100) showed necrotic tissue (N) and viable pheochromocytoma tissue (P). Limited viable tumor tissue revealed no malignant cells (B).

Figure 3.

The time course of the visceral fat area and serum adiponectin level. The visceral fat area (orange-colored area) was measured on CT cross-sectional scans obtained at the umbilical level in the spine position. Homeostasis model assessment of insulin resistance (HOMA-IR) = FPG (mg/dL) × fasting IRI (μU/mL)/405. Homeostasis model assessment of β-cell function (HOMA-β) = 360 × fasting IRI (μU/mL)/(FPG-63).